An epidural hematoma is a bruise that is located in the epidural space. It is located between the outermost meninges, the dura mater, and the skull bone. Normally, this space does not exist in the head and is only caused by pathological changes, such as bleeding.
The situation is different in the spine: here the epidural space exists in every human being and is filled with vessels and fatty tissue. Instead of the skull bone, here vertebral bodies form the outer boundary. Hematomas occur more frequently intracranially, i.e. in the head.
An epidural bleeding in the spinal column is possible, but less frequent in clinical routine. An epidural hematoma is caused by a previous bleeding. This can be caused in various ways, but is usually traumatic (caused by mechanical influences, e.g. a violent act or an accident). A hematoma in the head or spine requires urgent medical intervention and can lead to severe damage to the patient and death.
Causes
Since traumatic bleeding is the leading cause of epidural hematoma, bleeding of this type is strongly associated with the occurrence of craniocerebral trauma. In most cases, the trauma is caused by an accident, especially car accidents, in which the head is injured. Due to the extreme forces acting on the skull during an impact, damage to vessels can occur, causing bleeding and, as a consequence, haematomas.
A distinction can be made between haematomas caused by arterial and venous vessels. Due to the higher pressure in the arterial system of our circulation, a corresponding bleeding is more dramatic than one of the venous type. In most cases, the artery that supplies the meninges with blood – the arteria meningea media – is affected by the injury.
If a venous bleeding is the cause of the epidural hematoma, it is an oozing hemorrhage that develops more slowly due to the lower pressure in the system and also occurs less frequently. Since the epidural space in the spinal column exists physiologically (naturally), other causes are also represented here. A spinal epidural hematoma can be triggered not only by traumatic effects but also by vascular malformations, defects in the coagulation system or tumors. The vessels in the epidural space of the spinal column can be triggered not only by uncontrolled mechanical influences but also by medical actions (iatrogenic), such as the administration of injections. Taking blood thinners as part of the treatment of a disease can also promote the development of an epidural hematoma.
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